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Author manuscript
Pediatrics. Author manuscript; available in PMC 2016 November 03.
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University at Albany, SUNY, School of Public Health, Department of Health Policy, Management &
Behavior
Abstract
OBJECTIVE—To examine the association between maternal use of corporal punishment (CP)
against their 3-year-old children and subsequent aggressive behavior among those children two
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years later.
RESULTS—Multiple logistic regression analyses revealed that frequent use of CP (i.e., maternal
use of spanking more than twice in the prior month) when the child was 3 years-old was
associated with increased risk for higher levels of child aggression when the child was 5 years-old
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(adjusted odds ratio = 1.49 [CI=1.2–1.8] p<0.0001), even after simultaneously controlling for the
child’s level of aggression at 3 years of age as well as all of the aforementioned confounding
factors and key demographics.
risk for increased subsequent child aggressive behavior. Importantly, these findings cannot be
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attributed to the possible confounding effects of a host of other maternal parenting risk factors.
Increased and improved efforts to reduce the use of CP and promote the use of alternative,
effective non-physical forms of child discipline among U.S. parents are warranted.
Keywords
corporal punishment; physical punishment; spank; childhood aggression; child aggressive
behavior
When parents discipline their children, they generally do so in order to teach their children a
lesson, instill values, and/or improve their children’s current and future behavior. Corporal
punishment (CP) is one disciplinary strategy that remains highly prevalent in the U.S.
despite controversy surrounding its use.1 CP can be defined as “the use of physical force
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with the intention of causing a child to experience pain, but not injury, for the purpose of
correcting or controlling the child’s behavior (p. 3).”2 Percent estimates of U.S. parents who
have used CP vary from 35–90% depending on key modifiers such as age and gender of the
child and type of punishment specified (e.g., spanking, slapping).3–5 In a highly diverse,
U.S. population-based sample of parents with 3-year old children, a majority of the mothers
reported spanking their 3 year-old children at least once in the month prior to the interview.6
Furthermore, in a 2005 U.S. poll, 72% of adults reported that it was “OK to spank a child,”
with approval ratings being highest in the South and lowest in the Northeast.7
The normativeness of CP in the U.S. stands in contrast with the American Academy of
Pediatrics (AAP) recommendations, which are consistent those of other professional
organizations, e.g.,8, 9, 10 that “parents be encouraged and assisted in the development of
methods other than spanking for managing undesired behavior (p. 723).”11 Such concerns
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are rooted in the increasing body of empirical evidence suggesting that the risks of using CP
against children are likely to outweigh the potential benefits. A 2002 meta-analysis showed
linkages between CP of children and risk for poor outcomes in childhood including
aggressive and/or anti-social behavior, mental health problems, and physical maltreatment;
most of these risks carried into adulthood as well.12
Whether or not CP causes aggression is of particular relevance for public health interests in
short-circuiting the cycle of violence. Gershoff’s meta-analysis included 27 studies that
examined the link between CP and aggression and found a positive effect (d = 0.36);
however, most of these studies were not longitudinal.12, 13 In order to more strongly assert
that CP is a causal determinant of aggression, it is necessary to: 1) demonstrate a statistically
significant link between CP and aggression as well as, 2) temporality of this link, and to 3)
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control for the child’s initial level of aggression as well as 4) key potential confounders.12, 13
Other researchers have aimed to meet most of these conditions.e.g., 14–23 However, the
current study accounts for all four conditions, has a larger sample size and therefore more
statistical power than all but two of the aforementioned studies,22, 23 and controls for key
potential maternal parenting risk confounders and that have not previously been examined
simultaneously. The current study was designed to answer the following question: Does
maternal use of corporal punishment on a 3 year-old child lead to increased risk of
aggression when that child is 5 years of age, even after controlling for the child’s initial level
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of aggression and other important maternal parenting risk factors and demographics?
METHODS
Participants
The sample for this study was obtained from the Fragile Families and Child Well-being
Study (FFCWS), which oversampled for non-marital births. FFCWS is a population-based
cohort study of families from 20 large US cities. The original sample (n = 4898) was
obtained from 1998 to 2000 by sampling births within hospitals from cities with populations
over 200,000 in 1994; a detailed description of the FFCWS study design was published
previously.24 Four waves of data are available: baseline (around the time of the index child’s
birth), and when the index child was one, three, and five years old. Two interviews were
conducted when the child was age three and age five: a core interview (analogous to those
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from the first three waves) and an interview conducted with a sub-sample of mothers for the
add-on “In-Home Longitudinal Study of Pre-School Aged Children.” Questions about child
aggression and maltreatment were included in the latter interview. Most mothers (79%) who
completed the core interview also completed the “In-home” interview.
Mothers who met at least one of the following criteria were excluded from the study sample:
1) did not participate in the 3 year “In-home” interview (n=1610), 2) did not participate in
the 5 year “In-home” interview (n=799), 3) answered fewer than 50% of the child aggression
scale items so that a valid score could not be calculated (missing item values were imputed
when 50% or fewer of the scale items were missing) (n=21), or 4) did not report whether or
not they had spanked the index child at age 3 (n=7). Study participants (n=2461) differed
demographically from non-participants (n=2437) in that participants were: more likely to
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have some college education, be Black, be U.S. born, and be Christian (non-Catholic) or
non-religious. Participants and non-participants did not differ according to child’s gender,
maternal age, household income, or parents’ marital status at child’s birth.
The Institutional Review Board (IRB) of the Tulane University Health Sciences Center
reviewed this secondary data analysis study of publicly available data and considered it
exempt. All participant recruitment procedures were approved by the IRBs at the academic
homes to the FFCWS: Columbia University and Princeton University. Study participants
were compensated and informed consent was obtained at each interview. Again, further
details pertaining to the original study have been published elsewhere.24
Measures
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All data were provided via self-report from the mother. All child-related questions were
asked in regard to the identified index child.
Predictor Variable
Maternal use of CP: This variable reflects how frequently the mother spanked her 3-year
old child, a peak age for its use,3, 25 for “misbehaving or acting up” in the month prior to the
interview. Responses were coded and analyzed ordinally as: never (0), once or twice (1), or
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Dependent Variable
Index Child Aggression at Age Five: This variable was assessed using 12 items from the
Child Behavior Checklist version for age five,26 which asked if the child: argues a lot; is
cruel, bullies and shows meanness to others; destroys (his/her) own things; destroys things
belonging to family or others; is disobedient at home; is disobedient at school or in childcare
gets in many fights; physically attacks people; screams a lot; teases a lot; threatens people;
and is unusually loud (α = 0.82). Response options were: not true (0), somewhat or
sometimes true (1), or very true or often true (2). An average score for the 12 items was
obtained (mean=0.40, median=0.33, standard deviation=0.33). Because the variable was
highly skewed, it was dichotomized at the median and analyzed as “lower aggression” (score
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Index Child Aggression at Age Three: This variable was assessed using 19 items from the
Child Behavior Checklist version for age three,26 which asked if the child: Is defiant;
demands must be met immediately; is disobedient; doesn't seem to feel guilty after
misbehaving; is easily frustrated; gets in many fights; hits others; has angry moods;
Punishment doesn't change (his/her) behavior; screams a lot; is selfish or won't share; is
stubborn, sullen, or irritable; has temper tantrums or hot temper; is uncooperative; wants a
lot of attention; can't stand waiting, wants everything now; destroys things belonging to
family or other children; hurts animals or people without meaning to; physically attacks
people (α= 0.88). Response options were: not true (0), somewhat or sometimes true (1), or
very true or often true (2). An average score for the 19 items was then obtained (mean=0.62,
median=0.58, standard deviation=0.36). Because the variable was highly skewed, it was
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dichotomized at the median value and analyzed as “lower aggression” (score = 0–0.57)
versus “higher aggression” (score = 0.58 to 1.95).
Maternal Parenting Risks: We have shown previously that maternal use of CP against her
3-year old child is associated with her use of other harsh parenting (physical and
psychological maltreatmenta), child neglect, intimate partner aggression and violence, and
maternal parenting stress, depression, and consideration of abortion;6 use of alcohol and/or
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drugs also is linked with use of CP27 and parental punitiveness.28 Prior literature also has
shown links between most of these variables (especially harsh parenting, exposure to
intimate partner aggression and violence, parental depression and stress) and childhood
aggression.29–34
aThe term “maltreatment” will be used throughout for these variables rather than the more commonly used “aggression” term so that
this variable will not be confused with the outcome variable (child aggression).
Child maltreatment and intimate partner aggression and violence (IPAV): Three child
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maltreatment proxies were assessed with the Parent-Child Conflict Tactics Scale (PC-
CTS):35 physical maltreatment (4 items), psychological maltreatment (5 items), and neglect
(5 items). (The physical maltreatment scale usually contains a fifth item regarding spanking;
however, this item was removed so that it would not overlap with our main predictor
variable.) IPAV experienced by the mother since the index child’s birth, either from the
father or from a current partner, was assessed using seven items: three items from the
Conflict Tactics Scale36 were adapted to assess physical aggression and four from the
Spouse Observation Checklist37 and Lloyd38 were adapted to assess psychological
aggression. Because child physical and psychological maltreatment each were highly
skewed, they each were dichotomized at their median values (shown in Table 1) for analysis.
Child neglect and IPAV also were dichotomized (any vs. none).
Other maternal risks: Maternal parenting stress, major depression, use of alcohol and/or
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drugs, and unwantedness of the index child pregnancy were assessed. Stress was measured
using eleven items from the Parenting Stress Index39 (α=0.86). Depression was measured
based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition,40 for major depression using Section A of the Composite International Diagnostic
Interview – Short Form;41 detailed scoring methods have been described previously.42
“Unwantedness” of the index child pregnancy was approximated based on the mother’s
response to this baseline question: “When you found out you were pregnant, did you think
about having an abortion?” Parenting stress was analyzed as a continuous variable. All of the
other maternal risk variables were dichotomized (yes vs. no).
Maternal and Family Demographics: These variables were selected based on their
availability in the FFCWS dataset and previous empirical evidence suggesting their
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Statistical Analysis
Descriptive and bivariate statistics were conducted to examine associations between all
assessed maternal parenting risk factors/demographic characteristics and maternal use of CP
(Table 1) and child aggression at age 5 (Table 2). The Kruskal-Wallis test was used for the
continuous variables because the equal variances assumption generally was not met. Chi-
square tests were used with binary and categorical variables.
Four mutivariate logistic regression models were conducted to examine prediction of child
aggression at 5 years of age (Table 3). All four models controlled for parents’ marital status
at birth as well as interview city because these variables were part of the sampling design.
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Model 1 tested maternal use of CP when the child was 3 years of age as the sole predictor.
Model 2 added the child’s initial level of aggression at 3 years of age. Model 3 added the
eight assessed maternal parenting risk factors that may confound the association between CP
and child aggression. Model 4 added all of the assessed maternal and family demographic
characteristics.
RESULTS
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Almost half of the mothers reported no use of spanking (45.6%), 27.9% reported spanking 1
to 2 times in the past month, and 26.5% reported spanking more than 2 times. All of the
examined risk factors and demographics, except for parental relationship status and income,
were significantly associated with CP in bivariate analyses (Table 1). Use of CP was
significantly associated with other maternal parenting risks, including proxies for child
psychological and physical maltreatment and neglect, IPAV victimization, stress, depression,
substance use, and consideration of abortion. Respondents who were Hispanic, foreign born,
or Catholic all were at lower than average risk for using CP. Respondents who had a male
index child or a high school education, or who were younger, Black, or Christian (non-
Catholics) were at higher than average risk for using CP.
As with CP, all of the examined risk and demographic factors, except for race/ethnicity and
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nativity, were associated with child aggression (Table 2). These findings confirmed that most
of the examined factors might indeed confound the link between CP and child aggression
and therefore should be controlled for in the final analysis. As with CP, higher levels of each
of the assessed maternal parenting risks were associated with risk for higher levels of child
aggression. In addition, a few demographics also were relevant: children who were male or
whose mothers were younger, had lower education levels or household income, had no
religious preference, or had just a “visiting” relationship with the father were at risk for
higher levels of aggression.
Table 3 presents results from four logistic regression models predicting higher levels of child
aggression at age 5. Across all four models, mothers’ more frequent use of CP (more than
twice in the prior month) when the child was age 3 was a statistically significant predictor of
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higher levels of aggression when the child was age 5. At the bivariate level (model 1), more
frequent use of CP more than doubled the odds of higher aggression levels and less frequent
use of CP (1 to 2 times in the prior month) raised the odds by almost 40%. When the child’s
level of aggression at age 3 was included (model 2), the impact of CP use on subsequent
aggression was cut almost in half; this was because, as expected, having a higher level of
aggression at age 3 was a strong predictor of a higher level of aggression at age 5. When the
assessed maternal parenting risks were included (model 3) the impact of more frequent CP
use was cut by another 27% and less frequent CP use was no longer statistically significant.
The final model (4), which included all assessed demographics as well, suggests that the
odds of the child having a higher level of aggression at age 5 were raised by about 49% with
more frequent use of CP at age 3.
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DISCUSSION
Our study accounted for eight key “maternal parenting risks” for child aggression, including
other forms of harsh parenting besides use of CP (i.e., physical and psychological
maltreatment proxies), child neglect, IPAV, and maternal parenting stress, depression, use of
substances, and consideration of abortion. As anticipated, all of these factors were found to
be associated both with CP use and with child aggression and therefore had the potential to
be important confounders of this association. Although prior studies on this topic have
knowledge have accounted simultaneously for all of the confounds addressed in this study,
while also addressing the other key conditions (statistical significance, temporality, initial
levels of child aggression) that must be met in order to more strongly assert that use of CP
leads to higher levels of aggression in children.
We found that even after all of these potential “maternal parenting risk” confounds were
controlled for, more frequent maternal use of CP with their 3-year-old children raised the
odds of these children being more aggressive at age 5. This finding is consistent with dozens
of other studies that also have shown a significant statistical link between the use of CP and
child aggression including those summarized by Gershoff12 (e.g., 18, 20, 43, 44–53) and other
studies conducted since the time of her meta-analysis;e.g., 23, 54–57 it also is consistent with
studies that similarly controlled for child’s initial level of aggression.e.g., 15–23 Interestingly,
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once all of the demographics were accounted for in our final model, CP was the only
examined parenting risk factor that remained statistically linked (after a Bonferroni
correction) with subsequent child aggression. This finding seems to support a social learning
approach to understanding the cycle of violence,58 whereby the child learns to be aggressive
by being treated directly with aggression.
One may wonder, then, why maternal use of child physical maltreatment was not related to
child aggression. The physical maltreatment subscale of the PC-CTS contained five items
(Shook; Hit on the bottom with something like a belt, hairbrush, a stick or some other hard
object; Slapped on the hand, arm, or leg; Pinched; and Spanked on the bottom with your
bare hand). However, when the latter item was removed, there was a substantial drop in the
reliability coefficient for this subscale (from α = 0.63 to 0.48). Further, two of the remaining
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four items were reported very rarely (5 % (shook) and 8% (pinched)); in contrast, spanking
was much more common. Thus, the lack of association between maternal use of child
physical maltreatment and subsequent child aggression may be an issue of statistical power
rather than one of theoretical inconsistency.
There are several limitations to our study. First, this study focused on maternal use of CP
only and does not account for the father’s or other caregivers’ use of CP with the child.
Further, all variables in this study are based on mothers’ self reports; there is no
observational data and reports may be subject to biases related to recall and/or social
desirability. Also, there is always concern in observational studies that unmeasured
confounders may explain the associations found; however, even when this concern was
addressed to some extent in a prior study using hierarchical linear modeling, the link
between CP and child aggression remained.22
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Given the problem of unmeasured confounders, it is not possible to assert causality between
CP and child aggression in observational studies such as this. And, as with other studies of
risk behaviors (e.g., smoking), it would be unethical to randomize parents to either use CP or
not use CP given the existing evidence linking CP with associated harm in children. Thus we
must rely largely on evidence from observational studies, such as the current one, that aim to
account for as many other possible explanations of the association between CP and child
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aggression as possible.
CONCLUSIONS
This study adds strength to the growing body of literature suggesting that parental use of CP
leads to increased child aggression. This evidence-base suggests that primary prevention of
violence can start with efforts to prevent the use of CP against children. Pediatricians and
others concerned with children’s well-being know that CP is not a necessary form of child
discipline and that other more or equally effective, non-physical forms of discipline exist.
Reductions in parents’ use of CP (demonstrated in randomized clinical trials of parenting
interventions designed to treat conduct disorder in children) have been shown to reduce
children’s subsequent aggression;59 additional studies of this nature could aid in addressing
the question of CP as a causal agent in subsequent aggression. However, efforts to teach
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non-physical discipline strategies to parents via general pediatric office visits have met with
mixed success.60, 61 Research to further such efforts is needed given that parents cite
pediatricians as the professionals they are most likely to seek advice from regarding child
discipline.62 In addition, broader population-based efforts, such as social marketing
campaigns, are needed to shift perceived norms regarding CP62 and strengthen the AAP’s
message that other effective and less risky child discipline strategies should be used instead
of CP.
The authors would like to thank Mili Duggal and Ransome Eke for their assistance with
literature review and table construction, as well as Elizabeth Gershoff for sharing reviews of
key literature. The authors also thank the 2,461 study participants who gave their valuable
time and information to this study along with the reviewers for their helpful comments and
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Acknowledgments
Funding: This research was supported by the Centers for Disease Control and Prevention (grant R49
CE000915-02) and the National Institute of Mental Health and the National Institute of Child Health and Human
Development (R01 HD41141-02).
Abbreviations
AAP American Academy of Pediatrics
CP Corporal Punishment
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TABLE 1
Descriptive and Bivariate Statistics of Maternal Characteristics by Mothers’ Use of Corporal Punishment (CP) during the Month Prior to Interview when
Child was 3 Years of Age
Taylor et al.
Note: Kruskal-Wallis tests were conducted for continuous variables, for which ranges and medians are presented, because equal variance assumptions generally were not met. Chi Squared tests were
conducted for binary and categorical variables, for which % of mothers occupying each category are presented. Missing data for each variable equaled less than 1%.
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Taylor et al. Page 14
TABLE 2
Descriptive and Bivariate Statistics of Maternal Characteristics by Child Aggressive Behavior when Child was
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5 Years of Age
Note: Kruskal-Wallis tests were conducted for continuous variables, for which ranges and medians are presented, because equal variance
assumptions generally were not met. Chi Squared tests were conducted for binary and categorical variables, for which % of mothers occupying
each category are presented. Missing data for each variable equaled less than 1%.
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TABLE 3
Odds Ratios of Corporal Punishment (CP) and other Family Characteristics Predicting a Higher Level of Child Aggression at Age 5
Mother’s Use of CP
Mother spanked >2 times 2.03 (1.82 – 2.26) 0.000 1.59 (1.42 – 1.79) 0.000 1.43 (1.22 – 1.69) 0.000 1.49 (1.24 – 1.78) 0.000
Mother spanked 1–2 times 1.37 (1.17 – 1.61) 0.000 1.21 (1.02 – 1.45) 0.032 1.15 (0.93 – 1.40) ns 1.17 (0.94 – 1.44) ns
Higher Level of Child 3.79 (3.43 – 4.19) 0.000 3.34 (3.05 – 3.66) 0.000 3.35 (3.06 – 3.67) 0.000
Aggression at Age 3
Parenting stress 1.02 (1.01 – 1.04) 0.001 1.02 (1.01 – 1.04) 0.006
Use of drugs and/or alcohol 1.14 (0.87 – 1.50) ns 1.15 (0.88 – 1.51) ns
Considered aborting this child 1.04 (0.79 – 1.37) ns 1.04 (0.77 – 1.40) ns
Demographics
Child gender, boy 1.31 (1.09 – 1.58) 0.004
Maternal Education
Maternal Religion
Note: Missing data for each variable equaled 1.2 % or less. All models were adjusted for two key variables used in the sampling design: parents’ marital status at birth (married or unmarried) and city. In
Model 4, a Bonferroni correction for multiple tests suggests that only those findings with P<0.002 should be considered.